STD Awareness: “Sounding the Alarm” Over Another Antibiotic-Resistant STD

In 2012, the New England Journal of Medicine ominously stated, “It’s time to sound the alarm.” What followed was a description of the evolution of gonorrhea to all antibiotics we have used to treat it, including the last ones we had left. They closed the article with a warning: “The threat of untreatable gonorrhea is emerging rapidly.”

This summer, just five years after that alarm bell was sounded, the New England Journal of Medicine’s prediction came true. Reports of untreatable gonorrhea surfaced, shared in a World Health Organization press release: “Data from 77 countries show that antibiotic resistance is making gonorrhoea — a common sexually-transmitted infection — much harder, and sometimes impossible, to treat.”

An STD most people haven’t even heard of is rapidly evolving antibiotic resistance.

So maybe we should listen when a medical journal talks about the need to “sound the alarm.”

Sexually Transmitted Diseases, the medical journal of the American Sexually Transmitted Diseases Association, did just that in an editorial called “Mycoplasma genitalium on the Loose: Time to Sound the Alarm,” which accompanied two studies detailing antibiotic resistance in a little-known STD called mycoplasma genitalium, or MG for short.

“Let me get this straight,” you might be saying. “First you’re telling me there’s an STD called MG, which most people haven’t even heard of, and now you’re telling me I already need to worry about antibiotic resistance?”

We’ve known about a species of bacteria called Mycoplasma genitalium since the 1980s, and we suspected it could be an STD as evidence steadily accumulated for its sexual transmission and association with genital symptoms. It made headlinesin late 2015 upon the publication of further evidence that this bug is indeed sexually transmitted and capable of causing disease — and the media shared the story of a “new” STD called MG. Today, M. genitalium is credited with causing several diseases in the urinary and reproductive tracts, such as urethritis and pelvic inflammatory disease.

M. genitalium has been difficult to study — it is only over the past couple of decades that technology has allowed us to study these bacteria, along with other genital mycoplasmas. There is no FDA-approved test for MG, and it’s often misdiagnosed, confused for chlamydia or gonorrhea, often leading to infections that aren’t treated properly. And now, before we’ve even gotten a handle on MG, it’s rapidly evolving resistance to azithromycin and moxifloxacin, the drugs that can actually cure it.

As mentioned, the alarm-sounding editorial accompanied two studies that investigated antibiotic resistance in MG. The first, a study conducted in Spain, found that 35 percent of MG infections were resistant to azithromycin, the most common drug used to treat it. More alarming was the finding that 5 percent of MG infections were resistant to both azithromycin and moxifloxacin. The second study, conducted in Canada, found that MG was more common than chlamydia, gonorrhea, HPV, and trichomoniasis — and that more than half of infections were caused by antibiotic-resistant bacteria.

These two studies provide snapshots, but since MG isn’t well-studied across the world, we don’t have a good understanding of its prevalence or how common antibiotic resistance is. Nevertheless, previous studies have documented a rapid rise in antibiotic resistance in MG, with azithromycin resistance surpassing 50 percent in Japan, the United States, Canada, Greenland, and Norway. Other studies have found that MG might be more common than we realize, possibly even more common than chlamydia — which is by official count the most common bacterial STD in the country (maybe it will lose that title soon).

The best drug to cure MG, azithromycin, is quickly becoming ineffective, which dramatically limits our options. Moxifloxacin is more likely to be effective, but is also expensive and has more side effects. A drug called pristinamycin may be used to treat MG as well, but it’s not available in all parts of the world, including in the United States. The world desperately needs to support more research into new antibiotics, not just to combat the rise of this newly discovered STD called MG, but also to fight all kinds of other terrible diseases, from gonorrhea to staph infections to C. diff.

We can all do our part to fight antibiotic resistance. By not prescribing unnecessary antibiotics, doctors can help preserve these drugs for when they’re really needed. By taking antibiotics correctly, patients can help ensure they’re not helping the bacteria infecting them to develop resistance. And by pushing for agricultural reform, citizens can help put the brakes on what many say is the irresponsible overuse of antibiotics, which are used to make cows, pigs, chickens, turkeys, and other animals gain weight quickly, expediting their slaughter.

Sexually active people can reduce their risk by using barriers, such as condoms and dental dams, during vaginal, anal, and oral sex. They should also keep up-to-date on their STD status by receiving screening and treatment. You can drop by to pick up condoms, or make an appointment to be tested for STDs, at any Planned Parenthood health center.

Click here to check out other installments of our monthly STD Awareness series!

About Anna C.

Anna first volunteered for Planned Parenthood as a high school student in the 1990s. Since then, she has received a bachelor’s degree from UC Berkeley and a master's degree in epidemiology from the University of Arizona. As an ode to her fascination with microbes, she writes the monthly STD Awareness series, as well as other pieces focusing on health and medicine.